一种改良的鼻内镜下“三步法”翼管神经切断术的初步探讨

冀永进; 安云芳; 薛金梅; 李青峰; 索利敏; 张艳廷; 侯冉; 李强; 程冯丽; 赵长青

doi:10.13201/j.issn.1001-1781.2018.20.003

一种改良的鼻内镜下“三步法”翼管神经切断术的初步探讨

- 山西医科大学第二医院耳鼻咽喉头颈外科(太原, 030001)
基金项目:
国家自然科学基金面上项目 (No:81670914, 81870707)

山西省回国留学人员重点科研资助项目 (2014-重点3)

山西省重点研发计划项目 (No:201703D121003)

详细信息

通讯作者: 赵长青, E-mail:fahyj@126.com

中图分类号: R765.21

收稿日期: 2018-08-18

A preliminary study of a modified transnasal endoscopic three step vidian neurectomy

- Department of Otolaryngology Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, 030001, China

More Information

Corresponding author: ZHAO Zhangqing, E-mail: fahyj@126.com

Received Date: 18 August 2018

摘要

摘要: 目的: 探讨一种改良的鼻内镜下经鼻腔翼管神经切断术的术式。方法: 收集因鼻高反应性疾病住院的患者91例,包括变应性鼻炎49例,非变应性鼻炎42例。均经药物治疗效果不理想,症状未获得有效控制。术前CT定位翼管神经,术中在内镜引导下按照"三步法"操作规范完成:一是在内镜下经鼻腔蝶筛隐窝进入蝶窦,二是直视下向外侧方向和底壁方向磨除蝶窦前壁,三是暴露位于蝶窦底壁偏外侧的翼管并予以切断止血。结果: 所有患者均一次性完成翼管神经切断术,术前CT 100%定位翼管神经,术中内镜引导下100%准确切断翼管神经(经影像学和泪液分泌试验证实)。结论: "三步法"内镜下经鼻腔翼管神经切断术易于掌握,重复性强,副损伤少。
- 鼻高反应性 /
- 翼管神经切断术 /
- 内镜外科手术 /
- 蝶窦 /
- 改良术式
Abstract: Objective: The aim of this study is to explore an improved trans-nasal endoscopic surgical approach for vidian neurectomy.Method: Ninety-one patients with nasal hyperreactive disease were collected, including 49 cases of allergic rhinitis and 42 cases of non allergic rhinitis. All sufferers enrolled in the study have treated with medicine, but the symptoms were not effectively controlled. Preoperative CT localization of the vidian canal was performed in each candidate. During the surgery a "Three-step" surgical approach were followed under endoscopic guidance in accordance with the operation procedures. Briefly, such a three-step procedure consists of the following, that is, a transnasal endoscopic sphenoidectomy through sphenoethmoidal recess as step one, with enlargement of the sinus ostium along the junction of the anterior wall and the floor of the sinus until the exposure of the vidian nerve canal toward the lateral wall of the sinus as step two. The last step was further exposure of the vidian nerve going through the canal and electric cautery preventing bleeding from the neurovascular bundle in the canal.Result: All patients were completed successfully with 100% preoperative CT location of the vidian canal in the CT scan and 100% intraoperative accurate exposure of the canal and therefore the cut of the vidian nerve.Conclusion: "Three-step" endoscopic resection of the vidian neurectomy is easy to master and repetitive with less injury.
- nasal hyper-reactivity /
- vidian neurectomy /
- endoscopic surgical procedures /
- sphenoid sinus /
- improved surgical approach

HTML全文

参考文献(15)

[1]	GOLDING-WOOD P H.Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis[J].JLaryngol Otol, 1961, 75:232-247.
[2]	LEE J C, LIN Y S.Endoscopic vidian neurectomy:update on techniques and evidence[J].Curr Opin Otolaryngol Head Neck Surg, 2012, 20:66-72.
[3]	ZHANG H, MICOMONACO D C, DZIEGIELEWSKIP T, et al.Endoscopic vidian neurectomy:aprospective case series[J].Int Forum Allergy Rhinol, 2015, 5:423-430.
[4]	LEE J C, KAO C H, HSU C H, et al.Endoscopic transsphenoidal vidian neurectomy[J].Eur Arch Otorhinolaryngol, 2011, 268:851-856.
[5]	LEE J C, HSU C H, KAO C H.Endoscopic vidian neurectomy.An online video tutorial:how to do it[J].Clin Otolaryngol, 2010, 35:496-499.
[6]	TAN G, MA Y, LI H, et al.Long-term results of bilateral endoscopic vidian neurectomy in the management of moderate to severe persistent allergic rhinitis[J].Arch Otolaryngol Head Neck Surg, 2012, 138:492-497.
[7]	HWANG S H, JOO Y H, SEO J H, et al.Three-dimensional computed tomography analysis to help define an endoscopic endonasal approach of the pterygopalatine fossa[J].Am J Rhinol Allergy, 2011, 25:346-350.
[8]	ISAACS S J, GOYAL P.Endoscopic anatomy of the pterygopalatine fossa[J].Am J Rhinol Allergy, 2007, 21:644-647.
[9]	谭国林, 马艳红, 刘更盛, 等.鼻内镜下翼管神经切断术治疗中-重度持续性变应性鼻炎的远期临床疗效[J].中华耳鼻咽喉头颈外科杂志, 2011, 46 (6):449-454.
[10]	SU W F, LIU S C, CHIU F S, et al.Antegrade transsphenoidal vidian neurectomy:short-term surgical outcome analysis[J].Am J Rhinol Allergy, 2011, 25:e217-220.
[11]	中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎诊断和治疗指南 (2015年, 天津)[J].中华耳鼻咽喉头颈外科杂志, 2016, 51 (1):6-24.
[12]	KENNEDY D W, RAMAKRISHNAN V R.Functional endoscopic sinus surgery:concepts, surgical indications, and techniques[M]//KENNEDY D W, HWANG P H.Rhinology:diseases of the nose, sinuses, and skull base.New York:Thiema Medical Publishers, 2011:306-335.
[13]	CARDOSO V.CHESNÉJ.RIBEIRO H, et al.Neuronal regulation of type 2innate lymphoid cells via neuromedin U[J].Nature, 2017, 549:277-281.
[14]	KLOSE C S N, MAHLAKÕIV T, MOELLER J B, et al.The neuropeptide neuromedin U stimulates innate lymphoid cells and type 2inflammation[J].Nature, 2017, 549:282-286.
[15]	ZHAO C Q, ZHANG Y T, HE M.Effects of vidianneurectomy on allergic rhinitis[J].Chin J Otorhinolaryngol Head Neck Surg, 2017, 52:484-490.